Getting the Most Out of CIDP Treatments, Despite Lack of Breakthroughs

Jeffrey Allen, MD, an assistant professor of neurology at the University of Minnesota Medical School

Jeffrey Allen, MD

In treating chronic inflammatory demyelinating polyneuropathy (CIDP), physicians are faced with many challenges. On one hand, misdiagnosis of the rare condition is common. On another, overtreatment can quickly become an issue. And on a third, the treatment options for the condition have remained stagnant for quite some time.

But that has not stopped neurologists like Jeffrey Allen, MD, an assistant professor of neurology at the University of Minnesota Medical School, from trying to improve the field by informing those in the space of the pitfalls in diagnosis and treatment.¹

To provide a more in-depth look into how the field has failed to achieve a major breakthrough and what general practitioners need to know about CIDP, Allen spoke with NeurologyLive in an exclusive interview.

NeurologyLive: How has the field changed in the last 5 to 10 years? For you, what’s been the biggest step?

Jeffrey Allen, MD: People have talked about these issues for a long time, and now, in our current healthcare landscape, it’s really trying to make sure we’re very aware of optimized, tailored treatment and health care costs and being responsible with the medications we used. A lot of it is being more responsible and aware of these things.

From a treatment standpoint, the things that are first-line treatments are the same now as they have been for quite some time. There haven’t been a lot of breakthroughs. The PATH trial showing that subcutaneous immunoglobin was an option—an efficacious and safe option—for maintenance therapies was a very nice addition to what we can offer patients, but from a standpoint of what’s new and exciting and what’s different, there has not been a whole lot of movement recently.

How do you deal with that recent lack of movement?

Well, the focus on treating patients has evolved, and so trying to get the most out of the drugs we have is still a priority. Talking to patients about expectations and options is something that’s a priority, and although our evidence is limited on randomized control trials, there are still immuno-therapeutics that we use in patients that are difficult to control or have adverse effects that don’t include intravenous immunoglobin, and corticosteroids, and plasma exchange. There are other options, and some of those are more available now than perhaps decades ago, but what we lack is the evidence-based data to support their use.

What does the general neurologist need to know about CIDP treatment and identification?

It’s a rare disease and, it is, to some degree, a heterogeneous disease. It can present a number of different ways, and we know that there are variants to the very typical presentation of CIDP that can be difficult to recognize. For everyone, it’s helpful to reference existing guidelines on sort of the diagnostic criteria for these diseases—what we should be thinking about, how should we organize many different diagnostic tests, in order to arrive at a conclusion.

It’s also helpful to know, from a diagnostic and a treatment standpoint, that there are centers of excellence in CIDP and Guillain-Barré syndrome (GBS), and these are all listed by the GBS/CIDP International Foundation. There are multiple different centers of GBS/CIDP throughout the US and throughout the world, and for patients that are diagnostically challenging—or that aren’t but are going down through certain treatment pathways—getting a referral or second opinion from one of these centers can be very helpful. Most of our patients, not all of them, but most of them, don’t respond to these first-line treatments at least to some degree. Especially for patients who don’t, in an objective way, it’s always helpful to rethink about the diagnosis and try to make sure we really got it right. One of these centers of excellence can be helpful for this.

Transcript edited for clarity.

REFERENCE

Allen JA, Lewis RA. CIDP diagnostic

pit-falls

and perception of treatment benefit. Neurology. 2015;85(6):498-504.

doi

: 10.1212/WNL.0000000000001833.